The MT as morgue diener: not another dead-end job.
I was thrilled. The work fascinated me, and I had waited a long time for an opening. My duties as a medical technologist would continue, but now autopsies would call me away from the bench from time to time.
My family, friends, and co-workers did not share the excitement. The most common reaction was "Why would anyone want to do that?" This lack of enthusiasm reflected misconceptions about the job, even among some of my fellow technologists.
The fact is that serving as a diener in the morgue offers laboratorians a rare opportunity for increased responsibility. The potential for on-the-job continuing education is unequaled. While diener means servant in German, and Stedman's Medical Dictionary defines it as "a laboratory worker who assists in cleaning," our duties are far more complex. We assist the pathologist during an autopsy, much the same as the first surgical assistant does in the operating room.
Large hospitals generally employ one or more full-time morgue dieners. These individuals are rarely medical technologists. Medium-size hospitals may either employ a part-time morgue attendant or call in an outside diener via a beeper system. Small hospitals usually send out their autopsies.
Our institution tried several approaches before developing its present system. The morgue once had a full-time diener, but there wasn't enough work to maintain the position. The two pathologists then trained a phlebotomist as a part-time diener, but too often scheduling conflicts arose. In 1978, the pathologists started the morgue diener program for medical technologists.
All of us were selected because of our interest in the job. Several other interested technologists are waiting for a diener position to become available.
Training is largely done on the job. Newcomers attend their first autopsy as observers, viewing the various procedures more dispassionately than they might if they were participants. During the second visit to the morgue, they assist the diener. After that, they're on their own.
The medical center performs an average of one to three autopsies each month. According to hospital policy, "deaths resulting from unusual causes or occurring in a non-routine manner" must be referred to the medical examiner's office. Deaths occurring within 24 hours of admission and cases of suspected poisoning are examples. Should the ME waive jurisdiction, the pathologist will perform an autopsy only at the request of the attending physician. This request must be accompanied by the necessary authorization from the family of the deceased. Of course, the family can always request an autopsy, but this seldom happens.
The morgue diener's responsibilities include spending weekends on call, releasing bodies to morticians during the day shift, and assisting with autopsies. The three dieners rotate weekends on call. Our beepers allow us to travel as far as 75 miles and still answer a page. Since it usually takes a couple of hours for the hospital to process the necessary paper-work, we generally have plenty of time to get back to the hospital for an autopsy.
When a mortician comes to the hospital during the week, the dieners are responsible for releasing the body. While our main concern is to insure proper identification, we also help the morticians complete the transfer from the morgue to the hearse as quickly as possible. For example, a diener guides the mortician to the morgue and makes sure an elevator will be available for the return trip. We use a special route to avoid upsetting any patients or visitors in the corridors.
Proper identification is absolutely imperative in both the morgue and autopsy room. Horror stories about misplaced loved ones and autopsies performed on the wrong cadaver have been reported at many institutions. Ours isn't one of them. We never remove toe or wrist tags for any reason. Identification is scrupulously verified before an autopsy or transfer. Patients receive a wrist tag immediately upon admission, so inconclusive identification has not been a problem. In addition, since technologists also perform phlebotomy, we know most of the patients.
When the clinical laboratory is notified that an autopsy has been scheduled, it determines which diener will assist in the autopsy. All three technologists rotate among the various lab departments, and individual autopsy assignments depend on who has the lightest workload that day.
The diener must arrive at the morgue an hour or so ahead of the pathologist to check supplies, complete forms, label specimen jars, and prepare the deceased. The diener dons proper attire: a set of scrubs, an apron, and surgical boots. Hairnets, masks, and goggles are optional, unless the pathologist deems these precautions necessary due to the probable cause of death--hepatitis or tuberculosis, for example. Personally, I prefer to wear a hairnet and mask at every autopsy. The added protection makes me feel more comfortable, and the mask helps filter out the smells. A double set of gloves further guards against infection and allows us to perform such tasks as answering the phone without spreading contamination. We simply remove the outer gloves before touching the receiver and don a new pair when we return to the table.
Infection control is of utmost importance in the morgue. Even when the suspected cause of death is not contagious, secondary infections may be present. It is the pathologist's job to investigate all possible causes of death by examining all of the organ systems. This investigation not only exposes us to the pathogens but also to normal flora, which rapidly colonize the deceased shortly after death.
If we received any cuts or injuries during the autopsy, appropriate measures and safeguards are taken in the emergency room, and an incident report is filed.
The type of autopsy performed depends on the extent of permission granted. Procedures range from a physical inspection of the body and a punch-needle biopsy to a complete autopsy involving dissection of the torso, brain, and each limb. At our hospital, we frequently perform abdominal and thoracic cavity autopsies. We also dissect amputated limbs, often the legs of diabetic patients.
Although attending physicians frequently encourage a particular procedure that bears on the suspected cause of death, the pathologist can only perform the type of autopsy specified by the family. Thus, the relatives of a cardiac arrest victim may limit the pathologist to an examination of the thoracic cavity. If the pathologist deems it necessary, he can make an additional procedural request to the family via the attending physician.
Each autopsy--whether whole body or amputation--begins with a gross examination for bruises, edema, lacerations, and incisions. We also check for such foreign objects as bullets and invasive tubing. Cadavers can easily be damaged postmortem. A record of such physical markings eases concern about possible foul play when family members view the body. We show great respect for the deceased during the autopsy. Besides, morticians will report any unusual or unnecessary marks on the body.
During the autopsy, the morgue diener functions as the pathologist's first assistant. The pathologist makes the incision, and the diener holds the tissue aside to expose the vital organs and records such pertinent information as size, texture, color, shape, and weight. To prevent contamination, we use a clipboard that never leaves the morgue and a specially wrapped pencil for note taking. If our hands are messy, we rinse them--gloves and all--before recording the data.
Armed with the diener's data, the pathologist becomes a detective, collecting the pieces of the clinical puzzle and ultimately establishing the cause of death. Meanwhile, the diener preserves sections of each organ or the entire organ in formalin so that the pathologist can later re-examine the specimens in the histology laboratory.
Smaller pieces of tissue are selected for processing by the histotechnologist. The histotech removes any remaining water through a series of dehydrations, embeds the tissue in a paraffin block, and cuts ultra-thin sections (2 to 5 microns) with a microtome. Special stains are subsequently applied for microscopic observation of infections--parasitic, mycotic, and bacterial--and pathologically altered cellular structures.
Diseases that produce microscopic changes often produce gross changes as well. As a morgue diener, I am able to see the correlation between disease and its physical manifestations--it's the best continuing education seminar there is. For example, the calcified vessels found in a diabetic's limb are rough to the touch and result in a gangrenous toe or foot; the narrow veins are much more pronounced on microscopic examination.
It is also easy to recognize textural changes in lungs overwhelmed by pneumonia. The lungs develop adhesions and are easily punctured. Microscopically, the alveoli are damaged, which diminishes air intake.
Even when tissue slides are not made, the diener can learn pathology from the physical changes alone. In hypertension, the thickened ventricles are readily apparent on gross examination. When liver disease leads to heart failure, the congested liver takes on a "nutmeg" or speckled appearance. Diseases we have only read about suddenly gain new meaning, and so do the familiar warnings about smoking, dieting, and exercise. Since becoming a diener, I have no trouble keeping my New Year's resolutions to eat healthier foods and exercise faithfully.
Before suturing the body closed, the diener returns any organs or tissue not required for further study. The deceased is then wrapped in a shroud and returned to the refrigerated room until the mortician arrives. The diener cleans the instruments and autopsy table with gloved hands before degowning for a thorough scrub with an approved cleaning agent. Temperature charts are also changed at this time, and soiled bedding from the gurneys in the refrigerated room is discarded in a biohazard bag.
Depending on the type of autopsy performed, the diener can spend anywhere from 30 minutes to more than six hours assisting the pathologist. When autopsies are few and far between, one of us gives the morgue a weekly cleaning.
Why would a full-time medical technologist want to accept the additional responsibilities of a morgue diener? One reason is the added responsibility. The morgue assignments alter our daily routine and, as boredom wanes, our productivity and performance improve. Working in the morgue also gives us the opportunity to learn more about anatomy and physiology. The pathologist often delivers an informal lecture during the autopsy. Medical students and other physicians sometimes sit in, providing an even larger wealth of knowledge and paving the way for discussions. For my part, I think it's amazing to see firsthand how the body works and what happens when it doesn't.
Job fulfillment is another benefit. We deal with issues and limits of patient care that never arise in the laboratory. And we learn to face an ultimate reality. Some patients die and so, eventually, will we. A diener's work demands a personal understanding of death.
Hospitals benefit by using medical technologists as morgue dieners. Since we are already in the laboratory, we can easily handle morgue duties as they arise. The pathologist doesn't lose time waiting for an outside diener to arrive, and the hospital saves the cost of carrying a full-time diener for a part-time workload. Because we are paid only when morgue services are rendered, the institution gains round-the-clock coverage at a greatly reduced cost.
Though I'm rather slight, I can now move a 200-pound cadaver without sacrificing the dignity the deceased deserves. I have found that my stomach feels better when I eat something shortly before assisting and that it's unwise to drink too much tea when facing a six-hour session in the morgue. I also feel safer somehow if I wash the street clothes I have worn in the morgue separately, as soon as I get home.
The dieners receive a set rate for a weekend call. It's not that much money, but we do have a relative amount of freedom. As long as I stay within the beeper's 75-mile range, I can pretty much go about my business. When assisting during our regular laboratory shift, we receive our standard technologist's pay. If we have to stay late or come back to the hospital, we are paid overtime.
The work is sometimes depressing, but mostly it's fascinating. My only regret is that I was not yet a diener when the morgue received its most challenging case: a Klebsiella infection of the ear that wandered into the temporal bone of the skull. The patient's symptoms and presentation had defied medical textbooks, and the clinicians were mystified. It took several hours of study and more than 200 slides, but the pathologist was finally able to establish both the diagnosis and the cause of death. Assisting on this case would have a rare opportunity for any medical technologist.
While new acquaintances occasionally raise an eyebrow when they hear about my job, my family and friends have developed a genuine interest in pathology. Now, they always ask if I've done an autopsy recently. It has taken awhile, but they finally understand why I'm so lucky to be a morgue diener.